John Snow | British physician | Britannica.com British physician Francis Harry Compton Crick John Snow, (born March 15, 1813, York , Yorkshire, England —died June 16, 1858, London ), English physician known for his seminal studies of cholera and widely viewed as the father of contemporary epidemiology . His best-known studies include his investigation of London’s Broad Street pump outbreak, which occurred in 1854, and his “Grand Experiment,” a study comparing waterborne cholera cases in two regions of the city—one receiving sewage-contaminated water and the other receiving relatively clean water. Snow’s innovative reasoning and approach to the control of this deadly disease remain valid and are considered exemplary for epidemiologists throughout the world. Snow’s reputation in anesthesiology , specifically in regard to his knowledge of ether and chloroform , was considerable, such that he was asked to administer chloroform to Queen Victoria when she gave birth in 1853 to Prince Leopold and in 1857 to Princess Beatrice. Snow’s achievements are considered remarkable, given his humble origin and short life; a stroke caused his death at age 45. John Snow.

National Library of Medicine Education and contributions to anesthesiology Snow was born in York, England, where his father worked as a labourer in a coal yard. He was the firstborn in a family of nine children. At age 14, after spending his early years at a school in York, he left home and pursued three consecutive medical apprenticeships in various regions of Yorkshire. In 1831, when visiting coal miners, he had his first encounter with cholera, a disease that would later become the focus of his scientific endeavours. By 1836 Snow had begun his formal medical education, eventually receiving a doctor of medicine degree (1844) from the University of London . In 1849 he became a licentiate (licensed specialist) of the Royal College of Physicians of London, rising to an elite level in the medical profession. He lived, conducted research, and maintained a medical practice in the Soho neighbourhood of London. In 1846 Snow learned of the use of ether in America to relieve pain during surgery . He soon mastered its use, and in 1847 he was appointed as anesthesiologist at St. George’s Hospital.

Later that year he started working with chloroform . Finding the prevailing drops-in-handkerchief method to be too crude, he developed an apparatus that improved both the safety and the effectiveness of chloroform. His success with administering chloroform to Queen Victoria produced a dramatic increase in the social acceptance of gaseous anesthesia . Snow spoke extensively on his work with anesthetics and wrote the influential book On Chloroform and Other Anaesthetics, which was published shortly after his death in 1858. Broad Street pump and the “Grand Experiment” Britannica Stories Ringling Bros. Folds Its Tent Many British physicians investigated the epidemiology of cholera. The first cholera epidemic in London occurred in 1831–32, when Snow was still learning his craft. When the second cholera epidemic occurred, in 1848–49, he and others founded the London Epidemiological Society, intending to advise the government on ways to combat the disease. Snow reasoned that cholera was caused by a microbelike agent, or germ, that was spread through direct fecal contact, contaminated water, and soiled clothing.

However, his theory was at odds with the then prevailing theory that cholera was spread by bad air, or miasma, arising from decayed organic matter. The two etiologic hypotheses— germ theory and miasma—were widely debated, with available clinical and population-based evidence serving as the basis for arguments from both sides. The etiologic debate raged for many years. It was not until the causative organism, Vibrio cholerae (initially discovered in 1854), was well characterized in the 1880s that the debate was decided in favour of germ theory. Vibrio cholerae. Human Health: Fact or Fiction? Snow’s respected reputation in epidemiology arose from two classic studies of the third epidemic to reach England, which began in 1853 and lasted until 1855. The first study concerned the Broad Street pump outbreak of 1854, which killed many persons in the Soho neighbourhood. He used skilled reasoning, graphs, and maps to demonstrate the impact of the contaminated water coming from the Broad Street pump. The second study was the “ Grand Experiment,” also of 1854, which compared London neighbourhoods receiving water from two different companies.

One company relied on inlets coming from the upper River Thames , located away from urban pollution, and the other company relied on inlets in the heart of London, where the contamination of water with sewage was common. Snow showed the harmful effect of contaminated water in two nearly equivalent populations, and he suggested intervention strategies to control the epidemic. His ideas and observations, including innovative disease maps, were published in his book On the Mode of Communication of Cholera (1855). Later, in the 1930s, Snow’s work was republished as a classic work in epidemiology, resulting in lasting recognition of his work. John Snow and his work to benefit public health - Health Report - ABC Radio National (Australian Broadcasting Corporation) John Snow and his work to benefit public health First published: Image: Microscopic view of Cholerae bacteria which causes cholera. John Snow was an English physician in the 19th century. He is considered to be one of the fathers of modern epidemiology due to the fact that his work traced the source of a cholera outbreak in Soho, England, in 1854.

The London School of Hygiene and Tropical Medicine is the focus for celebrations of Snow's life and work, led by Paul Fine who's Professor of Communicable Disease Epidemiology at the school. Professor Fine spoke with Norman Swan about John Snow's role in establishing public health. Paul Fine: John Snow was born in New York. He came from a family of very modest means. His father was a carter. He was a smart young man, and ultimately he turned towards medicine, an apprentice with a physician in Newcastle for a number of years. And then he moved to London to complete his medical training and ultimately set up practice as a GP in Soho. Norman Swan: So, very near where we are sitting now. Paul Fine: A very near, 20 minutes walk away from where we are sitting right now. And among the problems which he confronted as a GP was asphyxia of the newborn. So he got interested in respiration and went so far as to actually carry out animal experiments in Soho. He also was concerned about arsenic fumes in candles.

And so it just happened that when ether anaesthesia was discovered and was first used in Boston 1846 by a man named Morton for a tooth extraction, the news came to this country, and a dentist on Gower Street just a few metres away from where we are sitting now, a dentist by the name of Robinson, heard about this and decided to use it in a tooth extraction. And he knew this guy John Snow not very far away who was interested in respiration and he invited him to observe this. And that was, I think, December 1846. Imagine what a miracle this was for medicine, the introduction of anaesthesia—just unbelievable. Snow immediately recognised a major problem. There were many anaesthetic deaths in the early years of anaesthesia from overdosing, because how was it often given? You just poured some on a cloth and held it over the nose and mouth. And of course the dose is a function of ambient temperature; the higher the temperature the more rapidly it evaporates, and so the higher the dose you give. And so Snow recognised you had to calibrate your dose with ambient temperature.

And within a month of observing the first use of ether anaesthesia in this country he published a table on this, and this shows… Norman Swan: He wasn't a man of small mind. Paul Fine: He wasn't a man of small mind. He even administered anaesthesia to Queen Victoria for two of her deliveries, became very well known for this. When he was working in Newcastle in the early 1830s he had witnessed the first cholera epidemic in this country. Norman Swan: And of course it is easy to forget that cholera was new to Europe in the 19th century. It wasn't new to Asia or India, but it spread here, probably through the British forces. Paul Fine: I don't think it came directly on a ship from the tropics, it came across the channel. At any rate, he had seen it and then it disappeared in something like 1833. It came back in 1849, and a lot of discussion, many deaths, and talk of miasmas. What were these miasmas? Some effluences associated with bad air.

And [he] recognised that there were many deaths in the populations living along the Thames and that, among other things, at that time flush toilets had recently been introduced, and the Thames was receiving the effluent directly from these, and the Thames turned into a sewer. And there was the famous year of the big stink when the odour was so bad that parliament couldn't even meet. So people attributed—understandably you might say—the disease to the foul atmosphere and smell. A very famous argument for this by a very famous man, William Farr, the statistician to the registrar general here who received the death certificates. And he drew a graph showing the cholera mortality rate as a function of elevation above the river Thames, and yes, the mortality was much greater low down near the Thames and much less in the more salubrious suburbs on the higher land. And he attributed it to the atmosphere, the low lying atmosphere around the river. Snow said this doesn't make sense. He had a number of instances where what looked like contact transmission of cholera, the cholera agent, had taken place. He said isn't it more reasonable to think that something that affects the intestinal tract is actually ingested rather than respired.

Norman Swan: And again, remember we didn't know about bacteria in those days. Paul Fine: That's right. He then proposed in the first edition of his book on the mode of communication of cholera—the first edition came out in 1849—that cholera was not attributable to some effluence, some miasma, something in the atmosphere; that it was attributed to some self-replicating agent that was in the excreta, the faeces of cholera victims, and it was transmitted if these were ingested by someone else. Then cholera disappeared by 1850, and was absent from this country until 1854, when it returned again. The first case was a sailor who came over from Hamburg, and it spread rapidly throughout London. And Snow recognised an opportunity to test his hypothesis, because over this period water companies had been set up and were laying networks of pipes around London and they were drawing their water from various places, some of them drew the water from the River Thames.

It happened that one of the companies had laid its pipes up the river at Thames Ditton, where the water was not polluted by the sewage of the city, and there was an area actually where the water of two companies, the Southwark and Vauxhall and the Lambeth companies, overlapped in South London. And Snow recognised that here was an opportunity where the same sort of population was receiving water from two different sources, and he thus could compare the mortality rates in individuals who were exposed, living in the same area, but exposed to water from two different sources. So starting in the summer of 1854 he personally carried out an effective cohort study of these populations. He received the death certificates from cholera deaths from that part of London. He confirmed the source of water for each of the cholera deaths. He recognised that he could distinguish the water from the two companies by adding some silver nitrate to the water, and if the water came from the river Thames it was brackish because it's still tidal and you get silver chloride deposition. And so he could actually confirm the source of the water. He would look at the water bill for the people, ask them, but actually confirm it with a chemical test.

In the course of this investigation, a dramatic epidemic started in Soho on 30 August. There had been a death or two, and within three days there were 100 deaths in a very small area. And so he dropped his study, if you will, he was distracted from the study in the south of London, and spent his time looking at the deaths in the area around where he was living. And specifically he got the death certificates, he looked at the addresses, he plotted them on a map, a very famous map, perhaps the most famous map in the history of public health, which showed a clustering of the deaths around a particular water pump on Broad Street that is now called Broadwick Street, not far from where we are. And amazingly, if you think that the deaths started to go up on 30 August, within a week he had received sufficient information, plotted the map, worked it out, interviewed individuals, convinced himself that this was the source of the outbreak. Norman Swan: No computers, no MRC grant, no research assistant. Paul Fine: Not at all. And then when sufficiently convinced, to go to the local council and prevail upon them to remove the handle of the pump.

And he did that on the 7th and they actually removed the handle of the pump on 8 September 1854. Now, that's Pump Handle Day, you should mark your diaries. I'm trying to get diary manufacturers to put Pump Handle Day for 8 September in every diary and calendar. Norman Swan: Because there's a bit of a mythology that he found it hard to convince people to remove the pump handle, but from the sound of it he didn't. Paul Fine: I can well imagine that some people might have said, well, that's our local pump, we don't want to walk another quarter mile for the water, leave it alone; however, he did prevail. Norman Swan: And what happened to the epidemic? Paul Fine: The epidemic actually was declining at that time, so the cynic said, 'Well, the epidemic was disappearing of its own, for various reasons,' because mostly everyone in the area had been infected, 550 people died within two weeks, but the logic of what he did and the pragmatism of his response has made this an iconic event in the history of public health.

And so many people will talk about 'looking for the pump handle of this', and 'how are we going to remove the pump handle for that', and it's a story…the actual numbers and the map that Snow developed are taught in epidemiology courses throughout the world. Norman Swan: And the legacy? Paul Fine: I should say another thing about Snow in that after he did this, Snow then turned this hypothesis to the parliamentary debate which was taking place at the time on what was known as the nuisance legislation. At this time there were industries such as tanneries which, as you may know, have a foul odour associated with them, along the Thames. And so people wanted to get the tanneries and what they called 'the nuisance industries' out of London. And one of the main arguments was that they are causing disease, and Snow actually testified, he was a man of great principle, he said, 'You may not like the odour but it's not causing disease.' And so many people in the, so to speak, establishment were not happy with this man and his hypotheses, and actually he was not very popular in many segments of the society at that time.

And when he died in 1858, for example The Lancet's obituary of him was condemning with faint praise. Here was a man who had made an extraordinary discovery and should have been recognised for this and there is a little side comment about Snow in his obituary. Norman Swan: So he only survived four years after the cholera? Paul Fine: That's right. Here's a man who started as a clinician and he saw a clinical problem and he started to investigate, even to the extent of doing animal experiments, and then extended that to anaesthesia, and then used this knowledge to criticise a prevailing idea about the epidemiology of cholera, and then setting up these beautiful studies. And he recognised full well the need to control for the similarity of the people or any potential differences in the people who would be drinking water from different sources in order to compare apples with apples. And the pragmatic nature of the response of carrying out an intervention and getting into the politics, and I think that's what science needs to do, to recognise problems in the world and work through, develop our understanding of them, develop the appropriate responses for society, and that means ultimately getting into the politics so that these things are implemented.

And now epidemiological methods are used, for example, in criminology, in education for evaluating different educational methods, and in economics. John Snow - The First Epidemiologist | Public Health Posted March 11, 2013 by Atif Kukaswadia, PhD in History of Public Health There have been many breakthroughs made off the blood and sweat of Epidemiologists. They have been at the forefront of eradicating polio, smallpox, reducing deaths from cholera and even detecting thalidomide as a teratogen. But if you’re going to talk about the history of epidemiology, you have to start with John Snow. John Snow was one of the first Epidemiologists, and he showed that cholera was water-borne, and debunked the (then-popular) Miasma theory. This Friday, organizations around the world will be marking his 200th birthday. I’ve listed a few events I’m aware of, but if your organization is hosting an event, comment with a link and I’ll add it below. Bonus points for those livestreaming or recording their events!

The Bacterium Vibrio cholerae | Picture courtesy the Dartmouth Electron Microscope Facility Back to our hero. As the summer of 1854 wound down, a major cholera outbreak struck Soho, a neighbourhood in London, England. From August 31st to September 3rd, 127 people died of Cholera. Within a week, 500 people had died and around one in seven people who developed cholera eventually died from it. This all occurred within 250 yards of the Cambridge Street and Broad Street intersection. John Snow came in and started his investigation. He examined the neighbourhood, and talked to everyone he could. He was looking for an underlying theme that linked these people together. He suspected some contamination of the water, but couldn’t find any organic matter in it, which you would expect under the Miasma theory. However, the more he looked, the more it seemed like the pump was responsible. Almost all the cases of cholera occurred close to the Broad Street Pump. There were only 10 cases that were closer to another pump.

Of these, 5 preferred the water from the Broad Street Pump (and got their water from the Broad Street Pump) and 3 were children who went to school near the Broad Street Pump. The last two were unrelated, and likely just background levels of cholera in the population. This was pretty convincing, but Snow mapped it out to make sure that he was on the right track. You might recognize the map – it’s what we use for our blog banner here on Public Health Perspectives. The map of all Cholera cases recorded by John Snow. Click to go to an interactive Google Map of the outbreak. | Photo courtesy Wikimedia Commons Snow provided more evidence for his theory that the pump was responsible for the cholera outbreak. For example, there was a brewery on Poland Street where 535 people worked, that had a pump on the premises. However, while cholera raged outside, only 5 of these people developed it. He explained this by pointing out that those who worked at the brewery were allowed to drink some of the malt liquor they made – and the foreman suspected that they didn’t drink any water at all. And even if they did, they used the pump on site.

The evidence Snow presented in favour of his findings were too compelling for the local council to ignore, and while there was resistance to this finding, Snow had said enough for the local council to remove the pump handle, halting the spread of the disease. But, as Snow later pointed out, he couldn’t be sure that this stopped the disease, and the incidence of the disease might have been declining. But the end result was the same – cholera cases went down. That is not to say that everyone believed him. The council may have taken the pump down, but it wasn’t until 1885, when Robert Koch identified V. cholerae as the bacillus causing the disease that he had proof of his theory. He was right, but wasn’t around to see this discovery himself. John Snow died on the 16th of June 1858, at the age of 45. His legacy still lives on, over a 150 years later. Epidemiology-related conferences still feature the Broad Street Pump in their logos and designs ( , ), and his story is one of the first budding epidemiologists hear.

He has also been immortalized by the John Snow Pub at the corner of Broadwick and Lexington Streets in London, England ( Google Maps link ). Membership in the John Snow Society ( ) requires you to visit the Pub – another reason to add that to your British vacation plans! The John Snow Pub in London, England While our techniques have advanced considerably since then, the basic principles established by Snow still exist in current Epidemiologic thinking. While some may argue that there were other pioneers of Epidemiology, including John Gaunt, Hippocrates and others, John Snow, if not the first Epidemiologist, is definitely one of the fathers of the field. Note: A version of this post appeared originally on my blog at MrEpidemiology.com .

Post navigation 1000+ images about The Broad Street Pump on Pinterest | Drinking water, John snow and London Forward Reverend Henry Whitehead,shown in 1884-Rev.Henry Whithead was instrumental in aiding Dr.John Snow in tracking the path of the cholera epidemic that stemmed from the cess-pool contaminated Broad Street well/pump.He was by all accounts a friendly man who was trusted in his community;without his contacts,Dr.John Snow would have been severely hampered in his information gathering.A friend has access to information one wont give a prying stranger..so much of the credit for Dr.Snows discovery… See More The Ghost Map: A Street, an Epidemic and the Hidden Power of Urban Networks. - Steven Johnson - Google Books The Ghost Map: A Street, an Epidemic and the Hidden Power of Urban Networks. 1 Review In Ghost Map Steven Johnson tells the story of the terrifying cholera epidemic that engulfed London in 1854, and the two unlikely heroes – anaesthetist Doctor John Snow and affable clergyman Reverend Henry Whitehead – who defeated the disease through a combination of local knowledge, scientific research and map-making.

In telling their extraordinary story, Johnson also explores a whole world of ideas and connections, from urban terror to microbes, ecosystems to the Great Stink, cultural phenomena to street life. Re-creating a London full of dirt, dust heaps, slaughterhouses and scavengers, Ghost Map is about how huge populations live together, how cities can kill – and how they can save us. What people are saying - Write a review The ghost map: the story of London's most terrifying epidemic--and how it changed science, cities, and the modern world User Review - Not Available - Book Verdict Popular science author, blogger, and Discover magazine columnist Johnson (Everything Bad Is Good for You: How Today's Popular Culture Is Actually Making Us Smarter) has written a fascinating book ... Read full review View all » About the author (2008) Steven Johnson is the author of the acclaimed books Everything Bad is Good for You (described as a 'must read' by Mark Thompson, head of the BBC), Mind Wide Open, Emergence and Interface Culture. His writing appeared in the Guardian, the New Yorker, Nation and Harper's, as well as the op-ed pages of The New York Times and the Wall Street Journal.

He is a Distinguished Writer In Residence at NYU's School Of Journalism, and a Contributing Editor to Wired. He is also the co-creator of several influential web sites: FEED, Plastic, and Outside.in. He has degrees in Semiotics and English Literature from Brown and Columbia Universities. He lives in Brooklyn with his wife and three sons. Steven Johnson hosts a web log at Recommended: Drinking Water - Scientific American Scientific American by James Salzman Overlook Press, 2012 ((&dollar;27.95)) Salzman's account of drinking water makes the liquid seem as mythic as the fountain of youth. He explores the engineering, politics and health implications surrounding humans' quest for water, as well as the toxins and changing climate that threaten our supply. The history includes how physician John Snow methodically traced an 1854 cholera outbreak to a single water pump in London, New York City's evolution from a disease-ridden metropolis to one that boasts about its tap water, and the innovative technologies that may avert global water poverty.

COMMENT AT This article was originally published with the title "Drinking Water" Advertisement | ABOUT THE AUTHOR(S) Marissa Fessenden Marissa is an intern at Scientific American. She recently graduated from the University of California, Santa Cruz's Science Communication Program. Follow on Twitter @marisfessenden Recent Articles University of Washington Biomedical Ph.D. Programs Biochemistry Initially recognized for incisive studies of the structure and function of proteins, and the mechanisms of enzyme action, the department of biochemistry branched out into other areas including aspects of molecular, cell and developmental biology. The faculty now explores such questions as how genes are expressed throughout development; how proteins and cells interact; how gene expression is modulated by environmental changes; how light energy is trapped in photosynthesis; how blood coagulates after injury; and how cells process information in the visual and immune responses. The techniques range from molecular structure determination by X-ray crystallography and NMR spectroscopy; genetic analysis using bacterial, yeast, fly, and mouse systems; protein structure prediction based on complete genome sequences; and picoseconds laser spectroscopy. We emphasize the value of using interdisciplinary approaches to attack important biological problems.

Our department provides a friendly, interactive environment where students and faculty exchange ideas easily and get to know each other well. You will have the opportunity to become acquainted with diverse areas of biochemistry through course work and seminars, while still concentrating on areas that are especially important for thesis research. contact: kelleyp [ a t ] u.washington.edu Bioengineering UW Bioengineering is home to some of the most exciting research being done in this discipline, and our inventions to date include ultrasound machines, the Sonic Toothbrush, microfluidics, smart biomaterials, medical imaging algorithms and applications, and high-performance computing. Faculty and students in the department are making discoveries and researching technologies that will revolutionize the healthcare system, across multidisciplinary endeavors in nanotechnology, biotechnology, modern biology, tissue engineering, drug delivery, physiology, computation and informatics, imaging, sensors, devices, and instrumentation. contact: dst [ a t ] u.washington.edu Biological Structure The department of Biological Structure is a modern anatomy department which studies structural organization ranging from molecules to the human body.

The faculty's scholarly interests can be roughly divided into four groups: cell and developmental biology; neural circuits in retina and brain; three-dimensional structure of biologically-relevant molecules studied by X-ray crystallography; and computer graphics and informatics. Within our department research interests span a range of study organisms (plants, animals, fungi) at all levels of organization (molecular, cellular, organismal, ecosystem), using a variety of theoretical and experimental approaches in the laboratory and in the field. contact: farrowj [ a t ] u.washington.edu Biomolecular Structure & Design The BIOMOLECULAR STRUCTURE & DESIGN (BMSD) PROGRAM at the University of Washington is an interdisciplinary graduate training program.The primary focus of research and training in BMSD involves the use and determination of atomic-level structures of biologically important molecules, with aims that include understanding the relationship between structure, dynamics, folding and function, predicting three-dimensional structures of biomolecules, and designing new molecules. The program is designed to facilitate cross-training among disciplines with the aim of preparing young scientists to enter this exciting and growing field of research. Students are supported through a variety of funding sources throughout their PhD studies.

Epidemiology The essence of epidemiology is to determine the distribution of diseases in populations, identify risk factors for diseases, and devise means to prevent the occurrence of diseases. The image of the Broad Street water pump at left represents these goals. When cholera killed 1000’s in mid-19 th century London , pioneering epidemiologist Dr. John Snow successfully traced one outbreak to polluted water flowing through this pump; when the pump was disabled and water obtained from cleaner sources, cholera deaths declined. UW epidemiologists are international leaders in the study a broad range of diseases, including (but not limited to) cancer, cardiovascular disease AIDS/HIV, other STDs, injuries, and reproductive conditions; and risk factors, such as behavioral, environmental, genetic, molecular, nutritional, and socioeconomic characteristics.We offer rigorous MPH, MS and PhD programs, judged by our peers to be among the top five in the nation, which provide training in epidemiologic methods and the epidemiology of numerous diseases and risks factors for disease.

Contact: epiapply [ a t ] u.washington.edu Genome Sciences Our goal is to address leading edge questions in biology and medicine by developing and applying genetic, genomic and computational approaches that take advantage of genomic information now available for humans, model organisms and a host of other species. Our faculty study a broad range of topics, including the genetics of E. coli, yeast, C. elegans, Drosophila, and mouse; human and medical genetics; mathematical, statistical and computer methods for analyzing genomes, and theoretical and evolutionary genetics; and genome-wide studies by such approaches as sequencing, transcriptional and translational analysis, polymorphism detection and identification of protein interactions. contact: bgiebel [ a t ] u.washington.edu Immunology The Immunology Ph.D. training program is designed to provide graduate students with the opportunity to pursue an understanding of immune responses in molecular detail and to do so in an environment in which the relevance for the understanding and management of human biology and disease is emphasized. This foundation enables our students to make fundamental discoveries and serves as a starting point for careers in academic, biotechnology and pharmaceutical research programs.

contact: pmccune [ a t ] u.washington.edu Microbiology The Department of Microbiology is strongly committed to its primary role in training researchers. Rapid advances in microbiology and the development of biotechnology have increased our understanding of all living systems, which in large part has been determined by studies of microorganisms. The research programs of the faculty reflect exciting areas of modern microbiology, which span a broad range of interests including microbial ecology, physiology, virology, and microbial pathogenesis in both animal and plant systems. contact: mears [ a t ] u.washington.edu Molecular & Cellular Biology MCB combines the strengths of the FHCRC and ten of the top UW departments (from Biochemistry to Pharmacology), together with other institutional settings such as the Institute for Systems Biology. As an educational consortium, the MCB Program strives to foster an innovative and flexible education-training program for graduate students interested in biomedical problems across a wide range of scientific disciplines. contact: maryell [ a t ] u.washington.edu Cholera and John Snow's Pump / Victorian Plumbing Doctor John Snow and the 1854 Soho cholera epidemic The Cholera Pump Cholera is a deadly disease spread through poor sanitation.

Several continental-scale pandemics struck in the 1800s, killings millions across Asia, Europe, and the Americas. Doctor John Snow discovered during the 1854 outbreak in London that the disease was being spread by a public water pump in the Soho area. His discovery was an early example of epidemiology. He disabled the pump and stopped the outbreak, but it took several years for medical science to catch up with Snow's insight. A pub named in his honor stands nearby today. Cholera Cholera is a bacterial intestinal infection causing profuse watery diarrhea, vomiting, fever and abdominal pain. The severity of the diarrhea and vomiting can quickly lead to dehydration and electrolyte imbalance. Infection is usually through drinking water contaminated by the watery diarrhea, colloquially called "rice-water stool". Cholera is a major cause of death world-wide, outside developed countries with advanced water treatment and sanitation. The last major outbreak in the United States was in 1910-1911. The first cholera pandemic was in 1816-1826. The disease began spreading in Bengal, in the Indian subcontinent.

By 1820 it had spread across India, killing 10,000 British troops and many times that number of Indians. The outbreak spread as far as China, Indonesia, and the Caspian Sea basin. An estimated 15 million people died in India between 1817 and 1860, and another 23 million between 1865 and 1917. The replica Broad Street Pump in Soho, with the John Snow pub in the background. The second cholera pandemic was in 1829-1851, reaching Russia, Hungary, and Germany in 1831, and London and Paris in 1832. 6,536 victims died in London, and the bacteria was established in Britain. There was a second major outbreak in Paris and London in 1849. London's outbreak killed 14,137. It also spread to other British cities, and by ships to North America. Several thousand died in the U.S., including former U.S. President James Polk.

Over 150,000 Americans and 200,000 Mexicans died during the pandemics between 1832 and 1849. The Painted Veil contains striking depictions of rice-water stool in a cholera pandemic in south-eastern China in the 1920s. Author W. Somerset Maugham was a physician who spent lots of time in south-east Asia and the Pacific. The film was shot in Guangxi Province — click here for pictures from my trip there. I had no rice-water stool, though. The Ghost Map by Steven Johnson describes the history of cholera, Snow, and his analysis. Further outbreaks in 1853-1854 killed about 3,500 people in Chicago (5.5% of the city's population) and 10,738 in London. The 1854 London Cholera Outbreak The 1854 outbreak in London was centered on the Soho area. Doctor John Snow analyzed the available information and determined that the main agent spreading cholera was a public water pump on Broad Street. The spring below the pump had been contaminated by sewage.

Snow didn't know what the contaminant was, but he found that the common attribute of victims was the use of water from that pump. Snow's analysis was one of the first examples of epidemiology. Despite objections, he convinced the government officials to remove the pump's handle. This change stopped that outbreak, but it took many more years before there was wide belief in contaminated water as the cause. "Miasma" or "bad air" was the preferred explanation. The government officials replaced the handle on the contaminated pump after the pandemic had subsided. Accepting Snow's explanation required accepting the fecal-to-oral transmission of disease, which they thought was too unpleasant for the public (although they seemed to think that the public could handle cholera itself just fine). The above picture shows a replica pump unveiled in 1992. Things have changed quite a bit in Soho since the 1850s. The pump was at the intersection of Broad Street and Cambridge Street — now renamed Broadwick Street and Lexington Street, respectively. It was close to the rear wall of today's John Snow pub, named in honor of the pioneering epidemiologist.

The John Snow Pub You can see the John Snow pub beyond the replica de-handled pump in the picture above. Here and below are some pictures from inside on a quiet mid-week night. Interior of the John Snow Pub. The John Snow is a Samuel Smith's pub, meaning that it only sells beer from that one brewery. It is kegged beer, dispensed through taps, and not hand-pumped from basement casks. You can see those illuminated taps along the bar but not long pump handles. So purists would say that it's not a "real beer pub". But it's a popular place in the neighborhood with low prices, a friendly atmosphere, some wonderful old architecture, and it's a nice place for a pint. There is a very low pass-through door between the left and right halves of the pub. Sinks and large urinal in the Gents' room. Snow's Analysis Snow used statistics and careful mapping of cholera cases to show that the Southwark and Vauxhall Waterworks Company was delivering sewage-contaminated water from the Thames river to homes, leading to an increase in the number of cholera cases.

Many families tried to have their raw sewage collected and dumped into the Thames to keep they cesspit from filling faster than their septic waste could decompose and be absorbed into the soil. He then showed that there was a cluster of cholera cases around this pump. Later research showed that this public well had been dug only three feet from an old cesspit which was leaking fecal bateria. The soiled diapers of a baby who had contracted cholera from another source, possibly the contaminated water delivered by the Southwark and Vauxhall Waterworks Company, had ended up in this cesspit. That cesspit was originally under a house, which had been rebuilt in a different location after a fire. The city widened the street and lost track of the cesspit, and later the well was sunk just an arm's reach away. Doctor John Snow's cholera map, by which he traced the origin of the 1854 Soho cholera outbreak to the pump. Snow wrote a letter to the editor of the Medical Times and Gazette — On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the [Broad Street] pump. There were only ten deaths in houses situated decidedly nearer to another street-pump.

In five of these cases the families of the deceased persons informed me that they always sent to the pump in Broad Street, as they preferred the water to that of the pumps which were nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street... With regard to the deaths occurring in the locality belonging to the pump, there were 61 instances in which I was informed that the deceased persons used to drink the pump water from Broad Street, either constantly or occasionally... The result of the inquiry, then, is, that there has been no particular outbreak or prevalence of cholera in this part of London except among the persons who were in the habit of drinking the water of the above-mentioned pump well. I had an interview with the Board of Guardians of St James's parish, on the evening of the 7th inst [7 September], and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day. These public health concerns have led to modern standards for hot water temperature, and thus to further worries about potential injuries. Where next? delicious A Sani-Flush blue border indicates a toilet, sink, shower, or other plumbing that I've used.

How long have my Toilets of the World pages been around? They started in the mid 1990s as a single page on a Purdue University server. The Internet Archive Wayback Machine lets you see what that looked like as far back as January 17, 1999 . My cromwell-intl.com domain appeared in September, 2001, although the Wayback Machine didn't notice its one enormous Toilet of the World page until January 17, 2002 . Some time soon after that I split it into categories, and the collection has grown ever since. In December, 2010 I registered the toilet-guru.com domain and moved the pages to a dedicated server. Programmed for defence : Article : Nature Nature 408, 769 (14 December 2000) | doi :10.1038/35048623 Programmed for defence BOOK REVIEWED-The War Within Us: Everyman's Guide to Infection and Immunity by Cedric Mims Academic: 2000. 228 pp.

$39.95, £24.95 ARCHIVO ICONOGRAPHICO/CORBIS Life in all its vulnerability: Hans Baldung's The Three Ages of Man and Death. On the eve of the presidential election, The New York Times found some small space in its editorial columns to praise the Bill & Melinda Gates Foundation for its attempts to lessen the burden of infectious diseases throughout the world. With US$21 billion in assets, the foundation could easily have distributed computers rather than vaccines to the remotest parts of the developing world. But as Bill Gates said: "The mothers are going to walk right up to that computer and say, 'My children are dying, what can you do?'. They're not going to sit there and, like, browse eBay or something." It was as if Gates had just finished reading Cedric Mims' The War Within Us. Mims has written an attractive and brief overview of the current understanding of immunity and infectious disease. The book is clearly intended for educated lay readers with a minimal background in science. The first third of the book is a reasonably accurate and simple discourse on the components of the immune system and how they work.

Although rendered in plain English, it is not oversimplified to the point of introducing gross inaccuracies. The remainder of the text discusses various infectious diseases and the wily pathogens that cause them. Although the way in which immunological specificity is generated must be among the greatest wonders of the natural world, it always evokes striking images of war, and attack and defence, and a whole vocabulary more appropriate to the Pentagon or any other government war ministry. Mims has totally succumbed to this type of imagery. Perhaps he feels it makes the contents more dramatic, and maybe it does. Scattered throughout the text the reader will find boxed vignettes of fascinating bits of history: how the cook who became known as Typhoid Mary, and who was herself immune to the typhoid bacillus, infected a long succession of her unwitting employers; how Carelton Gajdusek brazenly entered the New Guinea highlands and discovered kuru; how Ignasz Semmelweis, who introduced antisepsis into medical practice, died in an insane asylum of the very disease he spent his life trying to eradicate; and how the physician John Snow traced the source of a London cholera outbreak to the Broad Street water pump.

Those of us who grew up before the Second World War have vivid memories of the summer terrors brought on by polio epidemics, of relatives and neighbours dying of tuberculosis, of the ravages of syphilis among the gentry, and of children with whooping cough who were obliged by the health department to wear red armbands. Mims reveals in the course of this book his own medical history, from his mother's death from puerperal sepsis to the time he contracted rift valley fever in the laboratory. His interest in infection and immunity is, it seems, well founded. Rather disappointingly, no more than two pages of the book are devoted to a discussion of AIDS. Targeted as it is to a lay audience, the book might have been a good vehicle for saying more about the subject. Nonetheless, the reader is left with a broad understanding of the insidious destructiveness of infectious diseases, and also, no doubt, with a new appreciation of the Gates Foundation's efforts.

Question: English physician John Snow successfully traced the outbreak of what disease to a water pump?
Answer: Cholera